The Problem With Gluten-Free Foods

Depending how they're measured, sales of gluten-free foods represent somewhere between $4 to $10 billion annually, and there's no sign of this food trend slowing down anytime soon. Things are looking rosy for the food companies who sell the wildly popular breads, crackers, cookies, muffins, chips and snack bars labeled "gluten-free," but for those of us who eat them regularly, there may be a downside. Or three.

Gluten: Yep, you read that correctly. Apparently, not all "gluten-free" foods are in fact gluten free, and that's a serious problem for people with celiac disease, for whom exposure to even trace amounts of gluten can trigger an autoimmune reaction. Multiple recent studies that analyzed the gluten content of "gluten-free" foods -- both those foods considered "naturally gluten free" as well as some packaged foods explicitly labeled "gluten free" -- have found that a non-trivial percentage of these foods actually contained more than 20 parts per million of gluten, the threshold under which a food must fall in order to be considered gluten-free. For example, one study from Canada tested 600 flours made from non-gluten containing grains and found that about 10 percent of them contained over 20 ppm of gluten; in this study, the most likely products to be contaminated were soy flour, millet and buckwheat. Similarly, a recent U.S. study of 158 packaged foods showed that 5 percent of such foods labeled "gluten free" exceeded the 20 ppm threshold for gluten. Products that failed the gluten-free test ranged from unnamed brands of gluten-free breads, breadcrumbs and "herbal beverages" to cookies, hot cereal and a rice-based tortilla. While these studies indicate that the majority of gluten-free foods do live up to their claims, they expose the troubling fact that gluten-free labeling is not yet as reliable as it needs to be. Indeed, the recently enacted U.S. Food and Drug Administration labeling laws for gluten-free foods do not require manufacturers using the "gluten-free" claim to independently test their products and verify the claim.

[Read: Making Sense of the FDA's New Gluten-Free Labeling Law.]

If you have celiac disease and rely heavily on packaged foods in your daily diet -- or if you continue to exhibit positive celiac antibodies despite following what you believe is a strict gluten-free diet -- it may be worth considering the possibility that you're being exposed to gluten through your "gluten-free" food staples. Consider subscribing to registered dietitian Trisha Thompson's "Gluten Free Watchdog" service that independently tests the gluten content of several packaged foods per month, and check out tips from dietitian Shelley Case to help reduce the likelihood of gluten exposure from your purportedly gluten-free diet.

Gums. The vast majority of Americans who seek to reduce intake of gluten-containing foods don't have celiac disease and probably don't need to worry about occasional exposure to trace amounts of gluten. A noteworthy subset of gluten-free dieters includes those with Irritable Bowel Syndrome, who often avoid wheat in their diets due to its perceived adverse effect on digestive symptoms, such as gas and bloating. (This effect is increasingly being attributed to something in wheat other than the gluten, incidentally.) Unfortunately, there are plenty of other food ingredients that contribute to gas and bloating in these sensitive individuals, and among them are a category of food additives called gums.

Gums are naturally-derived food additives, and include compounds such as xanthan gum, guar gum and gum arabic. They are used liberally in gluten-free baking as texture enhancers to replace the elastic properties typically provided by wheat gluten, as their ability to thicken and stabilize doughs helps improve the consistency and moisture of notoriously dense and crumbly gluten-free goods. Indeed, food gums are found almost universally in commercial gluten-free baked goods, such as breads, cookies, cakes and muffins. (They're also used widely in other food applications, such as ice creams, lowfat yogurts and non-dairy milks.)

Alas, many types of gums happen to also be highly fermentable in the gut, which means they may contribute to gas and bloating in susceptible individuals -- particularly when intake is high. To be clear, food gums are not considered harmful or unhealthy, and consuming fermentable carbohydrates such as those represented by gums may be a good thing, healthwise, for their prebiotic effects. But for people who are more sensitive to pain associated with intestinal gas, high intake of food gums may just be too uncomfortable to bear. In these cases, I recommend choosing dry or crunchy alternatives to moist gluten free baked goods -- think gluten-free crackers or crispbreads rather than moist breads. And if gluten itself isn't the enemy, many of my non-celiac IBS patients can handle minimally-processed, gum-free spelt bread (not gluten-free) far better than many popular brands of gluten-free bread.

[Read: Making Sense of the Gluten-Free Food Frenzy.]

A largely undeserved health halo. National survey results suggest that the primary motivation for gluten-free food purchases may be the belief that such foods are generally healthier than their conventional counterparts. Whether this belief derives from the inherent bias conveyed by a "free-from" claim ('"if a food is claiming to be free of gluten, it's got to be a bad thing, right?") or from wheat-bashing bestsellers such as "Wheat Belly" and "Grain Brain," the fact remains that gluten-free foods enjoy a healthful halo among many consumers.

And yet, gluten-free packaged foods have one important thing in common with their glutinous counterparts: The majority of them are absolute junk. These include empty-calorie chips, crackers and bars that are high in starchy carbs and sugar while low in fiber; breads made from the least nutritious starches on the planet and held together by food gums; and high-glycemic cereals made from white rice flour or refined corn that's been sprinkled with vitamin dust. In other words, from a nutritional standpoint, many (most?) people without celiac disease may be far better off having a simple bowl of sugar-free Shredded Wheat, a gluten-containing piece of spelt bread or minimally processed Scandinavian crispbread than they would the vast majority of their gluten free alternatives today. And while I'm encouraged to see the nutritional quality of some gluten-free packaged foods improving, there still remains only a minority of gluten-free packaged foods that I'd consider truly nutritious and health-promoting. As such, I encourage my patients to consider the merits of a given food based on what it does contain rather than what it doesn't.

[Read: When a Healthy Diet is Anything But.]

There is no one single "best" diet, and a well-planned, minimally processed gluten-free diet can be as nutritious -- if not moreso -- as any other well-planned diet that includes wheat. Conversely, a gluten-free diet can be as junky as the junkiest wheat-based diet out there. Going gluten-free guarantees nothing about health (unless, of course, you have celiac disease), not does it guarantee digestive bliss in cases where gluten is not the problem. At the end of the day, good health is the product of what we do eat, not what we don't.

Tamara Duker Freuman, MS, RD, CDN, is a registered dietitian whose NYC-based clinical practice specializes in digestive disorders, celiac Disease, and food intolerances. Her personal blog, www.tamaraduker.com, focuses on healthy eating and gluten-free living.